Organization
KELLY A. PONCHERI DPM PA
Active
Other names
Foot & Ankle Institute of Central Florida
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY PONCHERI DPM (OWNER)
(239) 278-1155
Entity
Organization
Contact information
Practice address
4692 EXPLORATION AVE, LAKELAND, FL 33812-4107
(239) 278-1155
Mailing address
4692 EXPLORATION AVE, LAKELAND, FL 33812-4107
(239) 278-1155
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO 3478
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PO 3478
MEDICAL LICENSE
FL
Enumeration date
05/12/2011
Last updated
07/07/2011
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